Information Collection

Consumer Audience Feedback Team Screener

IC 247684 under ICR 202111-0925-006 · OMB 0925-0769.

Documents and Forms

Document Name Document Type
Form 1 Consumer Audience Feedback Team Screener Form and Instruction
1 Consumer Recruitment Screener Attachment 1 - Consumer Recruitment Screener 111021.docx Form and Instruction
1 Consumer Recruitment Screener Attachment 1 - Consumer Recruitment Screener 111021.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Consumer Audience Feedback Team Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Consumer Recruitment Screener	Attachment 1 - Consumer Recruitment Screener 111021.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.